Healthier Behavior Could Yield Sweet News

Improved behavior could save lives and money, two recent studies show.

A report published by the JAMA Network found that if just one percent of Medicaid recipients stopped smoking, Medicaid would save $2.6 billion a year, with a median annual state savings of $25 million.

Another study, posted by AHA Journals, concludes that improved nutrition labeling that better highlights products’ sugar content could change behavior in ways that would save more than $30 billion in health care costs over the next 20 years – and as much as nearly $60 billion if manufacturers respond to improved sugar labeling by re-engineering some of their products to have less sugar.

Learn more about the financial benefits of reduced smoking in the JAMA Network article “Estimation of 1-Year Changes in Medicaid Expenditures Associated With Reducing Cigarette Smoking Prevalence by 1%” and about the potential cost savings associated with better labeling of the sugar content in processed foods in the AHA Journals report “Cost-Effectiveness of the US Food and Drug Administration Added Sugar Labeling Policy for Improving Diet and Health.”

Low-Income Patients More Likely to End Up in Low-Quality SNFs

Dually eligible individuals are more likely than others to find themselves in low-rated skilled nursing facilities, recent research has found.

According to a study published in the Journal of Applied Gerontology, more than 50 percent of dually eligible individuals – those covered by both Medicare and Medicaid – who are admitted to skilled nursing facilities are served by facilities that have low (one or two stars) ratings under Medicare’s five-star quality rating system for nursing homes.  Overall, the dually eligible are 9.7 percentage points more likely than patients not on Medicaid to be served by lower-rated facilities.

The education of those individuals and their distance from higher-quality facilities are the two leading reasons.  According to the study, lower-quality skilled nursing facilities are more likely to be located in or near low-income communities.  Health status and race also are contributing factors.

Learn more in the Journal of Applied Gerontology article “Medicaid and Nursing Home Choice:  Why Do Duals End Up in Low-Quality Facilities?” and from the McKnight’s Long-Term Care News report “More than 50% of dual-eligibles end up in low-rated SNFs, study finds.”


Groups Seek Funding for Children’s Hospital Graduate Medical Education

Provide $400 million in funding for children’s hospital graduate medical education programs in the FY 2020 budget, 28 groups have asked congressional leaders in a recent letter.

The letter, sent to the chairs and ranking members of the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services, and Related Agencies and the same subcommittee of the House Appropriations Committee, notes that

Sustaining pediatric training programs at children’s hospitals to meet the need of children, now and in the future, requires bolstering our national commitment.  Support for training pediatric providers through CHGME (children’s hospitals graduate medical education) lags behind the per-trainee levels provided through other federal programs.  We cannot risk falling behind in advancing children’s health.  Ongoing workforce shortages need to addressed, most acutely among pediatric specialties such as developmental pediatrics, child and adolescent psychiatry, and pediatric genetics and genomics, and CHGME is mission to meeting this need.

Read the letter and see a list of the organizations that sent it here.…

MACPAC Recommends Changes in Medicaid Shortfall Definition

Hospitals’ calculation of their Medicaid shortfall would change under a recommendation that MACPAC voted to make to Congress.  That change, in turn, could affect hospitals’ future Medicaid disproportionate share payments.

Last week the Medicaid and CHIP Payment and Access Commission voted overwhelmingly to change how hospitals calculate their Medicaid shortfall:  the difference between what they spend caring for their Medicaid patients and what Medicaid pays them for that care.  Under MACPAC’s proposal, hospitals would need to deduct from their shortfall total all third-party payments they receive for the care they provide to their Medicaid patients.

If this proposal were to be adopted, it has the potential of changing Medicaid DSH allocations among the states and change the distribution of Medicaid DSH funds within individual states, although the Congressional Budget Office estimates that it would have little impact on either measure.

Complicating the MACPAC recommendation is last year’s federal court ruling that third-party payments could not be deducted from hospitals’ Medicaid shortfall totals because the Centers for Medicare & Medicaid Services lacks the authority to implement such a policy.  Making such a change therefore would require action by Congress.

Learn more about the MACPAC recommendation and its potential implications for hospitals …


The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The Commission wrapped up its work on the June 2019 Report to Congress on Medicaid and CHIP at the April meeting, with sessions reviewing four of the report’s five draft chapters on Thursday morning, and votes on potential recommendations later in the afternoon.

First on Thursday’s agenda was a draft June chapter on Medicaid prescription drug policy, which contained draft recommendations to provide states with a grace period to determine Medicaid drug coverage and raise the cap on rebates. The Commission then revisited hospital payment policy, with a draft chapter and recommendation on how to treat third-party payment in the definition of Medicaid shortfall when determining disproportionate share hospital payments. Next, commissioners considered two recommendations proposed as part of a June chapter on improving the effectiveness of Medicaid program integrity. The final morning session addressed the Commission’s proposed recommendation on therapeutic foster care.

The Commission returned from lunch for two presentations discussing preliminary findings of forthcoming congressionally mandated reports. The first afternoon session presented initial findings from a MACPAC review of state Medicaid utilization